Edoardo Baglivo

Multiple Evanescent White Dot Syndrome After Hepatitis B Vaccine

PURPOSE Hepatitis B vaccine has become an effective means of preventing complications of hepatitis B. However, it occasionally induces serious side effects. We report a case of multiple evanescent white dot syndrome (MEWDS) that occurred following hepatitis B vaccination. METHODS A 23-year-old woman with a one-week history of progressive loss of vision in the left eye and bilateral photopsia was referred for examination. Her symptoms appeared 24 hours after a booster intramuscular injection of hepatitis B vaccine. RESULTS Clinical examination, fluorescein angiography, and the course of events were typical of MEWDS. CONCLUSIONS This case demonstrates the occasional occurrence of MEWDS after hepatitis B vaccine and suggests that hepatitis B virus immunization may be a risk factor for this retinal condition.

Multiple Evanescent White Dot Syndrome Following Simultaneous Hepatitis-A and Yellow Fever Vaccination

Purpose: To report a case of multiple evanescent white dot syndrome (MEWDS) following simultaneous hepatitis-A virus (HAV) and yellow fever (YF) vaccination. Methods: Review of the clinical, laboratory, photographic, and angiographic records of a patient suffering from MEWDS. Results: A healthy 50-year-old woman presented with rapidly progressive left-eye visual loss, associated with photopsias and a para-central scotoma, one week after receiving simultaneous HAV and YF vaccination. Both anterior segments and right-eye fundus were unremarkable. Fundus examination of the left-eye disclosed papillitis with multiple, small, white, outer-retinal lesions. Angiographic tests were pathognomonic for MEWDS. Perimetry revealed left-eye blind spot enlargement. Initial inflammatory/infectious work-up was negative. Signs and symptoms resolved spontaneously within 6 weeks, with concomitant normalization of ancillary exams. Conclusions: The clinical presentation and the benign course were consistent with the diagnosis of MEWDS. No other aetiopathogenic factor than simultaneous HAV and YF immunization was identified, suggesting an autoimmune basis for MEWDS in predisposed patients.

Intraocular lymphoma following a primary testicular lymphoma in remission for 10 years

An 83-year-old Caucasian patient was referred with bilateral vitritis treated with topicalcorticosteroids for 6 months. The patient had had a history of right testicular B-cell lymphoma10 years ago, which was treated with an orchidectomy followed by six rounds of CHOP-typechemotherapy.Ophthalmologic examination revealed a best corrected visual acuity of 50/100 in the right eye(RE) and 30/100 in the left eye (LE). Anterior segment examination was normal. Intra-ocularpressure was 15 mmHg in both eyes.Fundus examination disclosed mild vitritis and multiple pin-like creamy lesions in the deepretina of both eyes. A fluorescein angiography disclosed multiple pinpointed hyperfluorescentlesions (Fig. 1).An anterior chamber aspiration revealed an inter-leukin-10 (IL-10) of 314 pg/ml (normal <8pg/ml) and 150 pg/ml in the aqueous of the LE and RE, respectively.A diagnostic vitrectomy of the LE confirmed the presence of atypical lymphoid B-cells withan

Thrombus and branch retinal vein occlusion

Branch retinal vein occlusion (BRVO) is often associated with arteriosclerosis. Typically the occlusion occurs at an arteriovenous crossing. We report a case of a previously healthy patient who developed a BRVO. Funduscopy and fluorescein angiography suggested an intravascular thrombus as the cause of the occlusion. The investigations performed were positive for systemic hypertension and hyperlipidaemia. After 2 months, fundus examination revealed disappearance of the intravascular thrombus, resolution of the macular edema and improvement of the — visual acuity. Certain physiological characteristics of the retinal circulation associated with hyperlipidaemia and systemic hypertension appear to favour thrombus formation.

Fuchs Uveitis Syndrome in the developing world.

Fuchs Uveitis Syndrome (FUS) is an inflammatory condition of unknown etiology. The classic features include widely scattered small stellate keratic precipitates, iris heterochromia, and minimal cell and flare in anterior chamber. Common complications include cataract, vitreous opacities, and glaucoma. The disease is also called as Fuchs heterochromic uveitis, Fuchs heterochromic cyclitis, and Fuchs heterochromic iridocyclitis in the literature, but as frank heterochromia may be absent or subtle, FUS is the currently preferred term.

Intraocular penetration of penciclovir after oral administration of famciclovir: a population pharmacokinetic model

OBJECTIVES We developed a population model that describes the ocular penetration and pharmacokinetics of penciclovir in human aqueous humour and plasma after oral administration of famciclovir. METHODS Fifty-three patients undergoing cataract surgery received a single oral dose of 500 mg of famciclovir prior to surgery. Concentrations of penciclovir in both plasma and aqueous humour were measured by HPLC with fluorescence detection. Concentrations in plasma and aqueous humour were fitted using a two-compartment model (NONMEM software). Inter-individual and intra-individual variabilities were quantified and the influence of demographics and physiopathological and environmental variables on penciclovir pharmacokinetics was explored. RESULTS Drug concentrations were fitted using a two-compartment, open model with first-order transfer rates between plasma and aqueous humour compartments. Among tested covariates, creatinine clearance, co-intake of angiotensin-converting enzyme inhibitors and body weight significantly influenced penciclovir pharmacokinetics. Plasma clearance was 22.8±9.1 L/h and clearance from the aqueous humour was 8.2×10(-5) L/h. AUCs were 25.4±10.2 and 6.6±1.8 μg·h/mL in plasma and aqueous humour, respectively, yielding a penetration ratio of 0.28±0.06. Simulated concentrations in the aqueous humour after administration of 500 mg of famciclovir three times daily were in the range of values required for 50% growth inhibition of non-resistant strains of the herpes zoster virus family. CONCLUSIONS Plasma and aqueous penciclovir concentrations showed significant variability that could only be partially explained by renal function, body weight and comedication. Concentrations in the aqueous humour were much lower than in plasma, suggesting that factors in the blood-aqueous humour barrier might prevent its ocular penetration or that redistribution occurs in other ocular compartments.

Bacterial keratitis after nonpenetrating glaucoma surgery

A 68-year-old woman had uneventful deep sclerectomy with a collagen implant in the left eye that was complicated by infectious keratitis 2 weeks later. Corneal scraping revealed the presence of Staphylococcus aureus. The patient responded to topical antibiotic treatment, and the corneal infiltration resolved, leaving a corneal scar. Bacterial keratitis may occur after nonpenetrating glaucoma surgery and should be included in the list of early postoperative complications.

Acanthamoeba detection in the anterior chamber.

Among the spectrum of infectious keratites, acanthamoeba keratitis (AK) represents one of the most difficult entities to diagnose and to treat properly, thus threatening the visual function. It affects immunocompetent patients and the main risk factors for the development of AK are the use of contact lenses, the exposure to contaminated water or contact lens solution, and corneal trauma.1 Clinically, this infection may appear as corneal stromal infiltrates, recurrent epithelial erosions, disciform keratitis, and keratoneuritis. An anterior uveitis and/or a hypopyon may be present too. The diagnosis is usually made by scraping and culturing the corneal tissue and by performing a corneal biopsy if the epithelium is intact. We report the case of a patient with an AK diagnosed by culturing the hypopyon. We would like to emphasise the value of this procedure in making the diagnosis in patient suffering from AK. An 81 …

Vascular occlusion in serpiginous choroidopathy

Serpiginous choroidopathy (SC) is a rare disease inducing a permanent loss of vision, caused by a progressive destruction of the retinal pigment epithelium and choriocapillaris. Until now, no aetiology or predisposing factors have been reported. SC, usually, affects both eyes and occurs in patients between the fourth and sixth decade, without any sex or race predilection. Clinically, deep cream-coloured lesions develop in the peripapillary region and then along the retinal vessels, centrifugally, inducing an atrophy of the retina. Other lesions may develop, isolated, in the posterior segment. The anterior segment is typically quiet; nevertheless, a mild anterior uveitis and/or vitritis have been observed. The course of the disease results in successive attacks and recurrences inducing permanent retinal atrophic changes and subsequently an irreversible loss of vision. Choroidal neovascularisation may occasionally develop. No specific diagnostic tests are available such that the diagnosis of SC is mostly clinical.1 A 30 year old Indian man presented with a history of painless progressive visual loss affecting the right eye. No other ophthalmological or systemic complaints were present. His medical history was unremarkable. Ophthalmological examination revealed a visual acuity of 20/50 in the right eye and 20/20 in the left eye without a correction in both eyes. Anterior segment examination revealed a mild inflammation with fine keratic precipitates on the inferior …

Chorioretinal anastomosis as a rare complication of radiation retinopathy

extent of subdural effusions. The blinded boy displayed weak light reactions and abundant subdural effusion, whereas the findings in the girl were nearly normal, indicating that a poor light reaction and the presence of massive subdural effusion may predict a poor prognosis. Retinal haemorrhages are important clinical signs of SBS, but brain damage seems to be the primary reason for visual loss, as has been described previously (Kivlin 2001). Our SBS cases confirm earlier observations that it is difficult to estimate visual acuity development based purely on retinal haemorrhage assessment. Retinal haemorrhages without subdural effusion in SBS have not been documented (Green et al. 1996; Blumenthal 2002). However, the girl, who made a recovery, suffered retinal haemorrhages with minimal subdural effusion, indicating that minor brain injury predicts good visual prognosis even though there may be abundant retinal haemorrhaging during the acute phase. The mechanisms that cause retinal haemorrhages in SBS are unclear. It has been suggested that subdural haemorrhage precedes retinal haemorrhage because less force is required to induce tissue injury, and the severity of brain trauma correlates with the extent of retinal haemorrhaging (Green et al. 1996). The extent of retinal haemorrhaging in each of our cases was almost identical, but the course of the recovery was very different, which does not agree with the mechanism proposed by Green et al. (1996). Intraretinal and subhyaloid haemorrhages are often followed by retinal detachment and choroidal and vitreous haemorrhaging (Green et al. 1996; Blumenthal 2002), but neither of our patients developed retinal detachment. Surprisingly, no vitreous detachment could be detected during follow-up. Our female infant, who recovered with minimal brain damage, but with massive retinal bleeding, is perhaps evidence that vigorous vitreous movements may also be an essential factor in evoking retinal haemorrhages. Retinal photographs of SBS children are not seen very often, although it is quite possible to take photographs of usable quality. We would like to encourage medical personnel to photograph the retinas of SBS cases for follow-up and for use by advocacy experts who take these cases to court. The babies in our cases showed only minor signs of external injuries. Their eyeballs appeared to be externally intact and they had no bone fractures. Nonetheless, major pathological retinal changes were observed during the acute phase. Therefore, general practitioners, paediatricians and ophthalmologists should be aware of the seriousness of SBS, even with minimal or no external signs of child abuse. Thus, consulting with an ophthalmologist is always advisable when SBS is suspected.